Roger and Darlene Gadley have shared a lot throughout their 41 years of marriage – and that includes being diagnosed with heart disease.

Roger presented the typical case of plaque build-up in his coronary arteries, high blood pressure, high cholesterol and Type 2 diabetes.

He was diagnosed despite having never suffered from any symptoms of chest pain or heart attacks.

Darlene is a different story.

Five years ago, the now 61-year-old woman suffered pain from her chest to her jaw.

The pain lasted on and off for about a year before she went to the doctors and was told she had low cholesterol, low blood pressure, and the arteries of an 18-year-old.

“If I continued to have chest pains they told me to go to a gastroenterologist because they said something was probably wrong with my esophagus,” Gadley said. “At that point I was just ready to live with it, I was like, `OK, I have a weird esophagus.”‘

But her husband read an article featuring Dr. Noel Bairey Merz, a cardiologist at Cedars-Sinai Medical Center and director of the hospital’s Women’s Heart Center as well as the Preventive and Rehabilitative Cardiac Center.

In the article, Merz was discussing coronary microvascular disease, a condition in which the heart’s smallest arteries are damaged or diseased. This affects how much oxygen is being delivered to the heart and is found to be more common in women, says Merz.

This condition, which accounts for one-third to half of heart disease in women, used to be considered benign until Merz’s “Y” study – her research focusing on women – linked it to heart attacks, strokes and death.

Merz says she began researching women because, although heart disease is currently the leading cause of death in both sexes, prior studies had primarily been based on men because data from the ’60s and ’70s showed more men than women were dying from heart disease.

As the mortality rate in men began declining thanks to new diagnostic and treatment strategies, in 1984 the number of women dying of heart disease began to surpass the number of men, says Merz.

This reversing trend was a sign that heart disease differentiated between genders, and the National Institutes of Health requested doctors begin researching it in women.

While eight out of 10 men will present classic symptoms of chest pain, clogged arteries and heart attacks, says Merz, less than 50 percent of women will have this kind of presentation of heart disease.

“Women’s symptoms can be different, they can look different on a stress test or on an angiogram, so if you don’t get the pattern recognition (for women) then you have diagnostic uncertainty and we typically don’t treat if we don’t think that’s what the disease is,” Merz said. “We say, `Go see the gastroenterologist. Go see the psychiatrist. This is not a heart problem.”‘

Women are less likely to complain about pain, Merz says, and they most commonly describe vague, lingering symptoms such as indigestion, fatigue and shortness of breath, says Merz.

Stress tests, such as running on a treadmill while being monitored, also can show different results than those presented by men.

“The most common sort of deal-maker difference is that the women will have a low functional capacity, an abnormal electrocardiographic (EKG image) or clinical response and yet the noninvasive imaging response with an echo (echocardiogram) or a SPECT (scan) will be normal,” Merz said.

“Physicians tend to overvalue the pictures – the noninvasive imaging – and they ignore the rest of it and they say you’re fine. And you know, that’s a mistake. I mean, the research that we did in the Y study has clearly demonstrated that that’s a mistake and women at risk are missed all the time and then they’re not treated. If we fix that, that would save a lot of lives.”

That is exactly what happened with Darlene Gadley.

After seeing the article, she drove from her home in Fresno to see Merz at Cedars-Sinai.

Merz was able to identify Gadley’s symptoms and diagnosed her with microvascular disease.

“I can get really proactive about this sort of thing. When you have something like that, you have to be smart and do what’s best for you,” Gadley said. “It’s a life-saving kind of thing, truthfully. If your heart goes out on you …”

Gadley is just one of many women with microvascular disease who don’t present the traditional symptoms or risk factors.

With microvascular disease, traditional risk factors such as hypertension, diabetes and high cholesterol account for only 20 percent if cases, says Merz.

Some uncommon risk factors that women should be aware of, says Merz, include:

Irregular menstrual cycles caused by anovulatory cycling (a menstrual cycle in which ovulation fails to occur or there is inadequate ovulation).

Having a good cholesterol level (HDL) less than 50 milligrams per decimeter (it’s 40 milligrams per decimeter for men).

High blood pressure and high blood sugar during pregnancy.

Premature menopause (before age 40).

Cigarette smoking is a more potent risk factor for women than for men because the same amount of smoke is going into a smaller body.

Depression, loneliness, anxiety and having a low socio-economic status, because people who suffer from these are less likely to take care of themselves.

Merz says women have to take their health into their own hands until this female-pattern recognition for heart disease is observed by all physicians.

She sites breast cancer as an example.

“Women are quite aware of breast cancer – we have an over 85 percent compliance with mammography guidelines now, meaning women have decided to own that and they do it,” Merz said. “So if we could do that with heart disease, if we could get women to go in and get screened annually just with their blood pressure and their blood cholesterol, and then be aware and know their numbers. … That’s how you make things go forward.”

The average age for onset of heart disease among women is the mid-70s, but Merz warns women that the average does not mean much when the disease is so prevalent.

Because of this, Merz says women should begin educating themselves on how to be heart healthy when they are in their teens, and it is recommended that adults get their blood pressure and cholesterol checked annually starting at age 18.

Merz also is working on finding a test to administer to 50-year-old women that would be economical and effective enough to reduce the mortality rate of heart disease.

“Women on average get their heart disease 10 years after men, so everyone’s thinking it’s a 72-year-old female problem, but it’s really not,” Merz said. “It’s the big white elephant in the room and we just missed the boat thinking about these 72-year-old women.”

Heart-healthy tips

Cardiologist Noel Bairey Merz, director of the Women’s Heart Center at Cedars-Sinai Medical Center, says these five health habits can reduce a woman’s chance of heart disease by more than 80 percent:

1.) Don’t smoke and don’t allow people to smoke in your home or in your workplace.

2.) Maintain a heart-healthy nutritional regimen, which includes 10 servings of fruits and vegetables daily, nuts or beans every day, fish twice a week and dessert rarely.

3.) Exercise or do other physical activity for at least 30 minutes a day. Daily-living activities count if you walk 10,000 steps a day.

4.) Avoid being obese, defined as being 20 percent over your ideal body weight. Research shows if you are overweight – as opposed to obese – you need to be at least fit and meet exercise standards.

5.) Consume a single serving of alcohol daily with food, unless a physician recommends against it due to health problems or you have a history of alcoholism. A single serving of alcohol is 2 ounces of hard liquor, 4 ounces of wine or 12 ounces of beer.

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